Testicular cancer is the most common malignancy in men ages 15 to 35,
striking at a time when a young man cannot believe he could be at risk of
cancer. The most aggressive form, non-seminomatous testicular cancer, is
often diagnosed at an advanced stage. Twenty years ago, it was nearly uniformly
fatal if it had 
spread beyond the testicle. But clinical
research and therapeutic trials have completely changed the outlook on this
once dread disease for patients, their loved ones, and the medical community.
The first trial of the highly curative regimen, cisplatin, vinblastine,
and bleomycin (PVB), was initiated in 1974; initial results were reported
in May 1976; and the full study report followed in 1977.
In 1976, I was newly married and just starting my first job after college. I told myself the lump I felt in my right testicle couldn't be serious, but I was scared. Descriptions of testicular cancer in the medical reference books I found in the library were even more frightening. I retreated into my private terror, praying I did not have cancer. Later, when the back pains started, I couldn't hide it any longer from myself or my wife, and we went to the doctor. I was diagnosed with advanced testicular cancer, but the oncologist told us about the dramatic success of a new, four-month chemotherapy regimen. Desperate, I took the new treatment. That was nearly 20 years ago. --Bill
This man was in the first national wave of men cured of non-seminomatous testicular cancer as use of the successful PVB regimen spread even before medical reference books could print the advances. Within a year of the first research report, mortality rates from testicular cancer were falling nationwide. Now, about 80 percent of men with advanced disease are cured, and overall about 90 percent are cured. But success brought new research questions to be addressed in clinical studies.
By 1985, we were finally convinced that Bill was cured, but we wondered if it was possible, or safe, to start a family. The doctor said studies were underway to determine the fertility of cured testicular patients, and she asked if we would participate. We were happy to, considering how much we had benefited from the earlier clinical studies. We found out his sperm count was low, but that having children might be possible. The few children born to patients up to that time were reported to be healthy. Our little girl is now seven. --Bill's wife
Clinical researchers have recently been studying how to maintain high cure rates while decreasing the side effects of treatment and improving quality of life. We now know that less toxic drugs can be used to achieve the same cure rates. Some patients can receive fewer courses of chemotherapy, and carefully selected patients can even be treated with surgery alone, reserving chemotherapy for relapse, yet achieving the same cure rates. Nerve-sparing surgery can be used to preserve the nerves that control ejaculation. Finally, we are studying the genetic and molecular markers that may distinguish different types of testicular cancer.
This gratifying success since 1975 also had its effect on the medical community. One doctor recalls:
As a medical intern in the summer of 1973, one of my first patients had advanced non-seminomatous testicular cancer. My attending physician described the dismal prognosis on morning rounds. The patient died within six months. Before I finished my residency in 1976, we were treating and routinely curing such patients with four monthly courses of PVB chemotherapy. I saw with my own eyes the value of clinical research. That's part of the reason I went into research as a career.